Michael Goldfarb (Media Relations Manager, MSF-USA): Thank you very much for joining us today. Welcome to this media briefing with Doctors Without Borders/ Médecins Sans Frontières (MSF). My name is Michael Goldfarb. I am the media relations manager for MSF in New York. MSF announced today that it is closing all its medical humanitarian activities in Somalia, due to unacceptable levels of extreme violence directed against its personnel. Armed groups and civilian authorities have tolerated, condoned, and in some cases supported these acts of violence against aid workers.

Dr. Unni Karunakara, MSF's international president, will now join us from Nairobi to discuss this momentous decision and also its significant consequences.

Also on the line is Arjan Hehenkamp, general director of MSF's operational center in Amsterdam, who is joining us from London and who can provide us with insights into MSF's operation in Somalia.

A Q&A will immediately follow Dr. Karunakara's remarks. Our statement explaining this difficult decision can be found on www.msf.org and at doctorswithoutborders.org.

Unni, the floor is yours.

Dr. Unni Karunakara, MSF international president:

Earlier today I announced that Médecins Sans Frontières, MSF, will begin the closure of all medical humanitarian activities in Somalia starting today.

This decision has not been taken lightly. Working continuously in Somalia since 1991—that's 22 years—we are very aware of the immense needs that face the Somali people. The closure of our activities is a direct result of extreme attacks on our staff in an environment where armed groups and civilian leaders increasingly support, tolerate, or condone the killing, assaulting, and abducting of humanitarian aid workers. And I want to repeat this again: increasingly support, tolerate, or condone the killing, assaulting, and abducting of humanitarian aid workers.

In some cases the same actors, particularly but not exclusively in south central Somalia, with whom MSF have had to negotiate safety, have played a role in the abuses against MSF staff, either through direct involvement or tacit approval. Because of their actions, hundreds of thousands of Somalis will now be effectively be cut off from medical humanitarian aid.

Already in the first half of this year, MSF medical teams treated more than 300,000 people in Somalia. Throughout our 22 year history in Somalia, MSF has negotiated with armed actors and teams of all types. The exceptional humanitarian needs in the country have pushed MSF and our staff to tolerate unparalleled levels of risk—much of it borne by our Somali colleagues—and to accept the serious compromises to our principles of independence and impartiality.

But we have now reached our limit.

The most recent incidents include the brutal killing of two MSF staff, Phillipe and Kace, in Mogadishu in December 2011, and the subsequent early release of the convicted killer, as well as the abduction of two MSF staff in the Dadaab Refugee Camp in Kenya, that ended only last month after a 21-month captivity. These two incidents are the latest in a series of extreme abuses. Fourteen other MSF members have also been killed, and we have experienced dozens of attacks on our staff, ambulances, and medical facilities since 1991.

We are ending our programs in Somalia because there is an increasing imbalance between the risks and compromises that our staff must make, and our ability to provide impartial care to the Somali people. The killing, the abductions, and the abuses against our staff in Somalia have meant that MSF had to take the exceptional measure of hiring armed guards. This is not something that we do in any of the other countries where we work. We have also had to tolerate extreme limitations on our ability to independently assess and respond to the needs of the Somali people.

At a minimum, all warring parties and communities must accept and recognize the value of humanitarian action. We cannot provide care if the principles of independence and impartiality are not respected. If negotiated safety assurances for patients and staff are not sustained, we cannot work in such a volatile environment. Respect for humanitarian principles, which is always a very difficult thing in conflict zones, no longer exists in Somalia today. All actors in Somalia must demonstrate through their actions and willingness an ability to facilitate the safe practice of humanitarian workers and the delivery of aid based solely on need. Unfortunately the Somali people will pay the highest cost.

Much of the Somali population has never known the country without war or famine. Already receiving far less help than is needed, many will no longer find the healthcare they require. In several places, MSF has been effectively the only organization providing quality medical care. For example, in Mogadishu MSF runs the only pediatric intensive care unit in the city, while in Jowhar, women will have nowhere to go for emergency C-sections. MSF will be closing its medical programs across Somalia, including in the capital Mogadishu and the suburbs of Afgooye and Daynille, as well as in Balad, Dinsor, Galkayo, Jilib, Jowhar, Kismayo, Marere, and Burao.

On a personal note, this is undoubtedly the most difficult announcement I've had to make as international president of MSF. In 1995, my first humanitarian assignment with MSF was to set up a TB program for Somalis. Eighteen years later, I'm sad to say nothing has changed substantially for these people. People continue to fight for their survival every day. I sincerely and personally regret that we must stop providing life-saving care in Somalia today.

Michael Goldfarb:

We will now begin the question and answer period. Please be advised that neither Dr. Karunakara, Arjan Hehenkamp, nor any other MSF representative will provide any details surrounding the captivity and release of the two MSF staff members abducted in the Dadaab Refugee Camp in Kenya in October of 2011, and released last month.

Please state your name and affiliation when asking your question. Thank you very much.

Jason Straziuso, Associated Press:

Thank you Dr. Karunakara. My question is, how long had this action been planned, and were you waiting for the release of the two kidnapped women to take this decision? Also, did the U.N. compound in June play any role in this decision?

Dr. Karunakara:

It was not one incident that has triggered this decision. Like I said, over the past 22 years we have accepted the risks that Somalia has presented, and we did our best to adapt our operations in order to ensure that people received the care they needed. But in the last 22 years we've had 16 killings – 16 staff members have been killed. And also during this time we've had dozens of attacks against our staff, our vehicles, et cetera, et cetera. So the final straw was the realization that authorities and armed actors and community leaders were actively supporting or tacitly approving the attacks, the abductions, the killings against our staff. That goes for the final straw, I guess.

I just wanted to stress the fact that we don't rely on the U.N. in Somalia or the government, or actors such as them, for our protection. Our security, our safety guarantee, comes through negotiated actors', or community mediators', safety assurances. This is how we operate. [The attacks on the U.N. in Somalia] played no role in the decision we've made.

Savi Xaldejoa, La Vanguardia:

Is this decision affecting the work of MSF in Dadaab in the frontier of Kenya and Somalia? And what will happen with the workers, the staff that was working with MSF in Somalia now? It's 1,800 people. What will happen with them?

Dr. Karunakara:

We completely recognize that Dadaab is a dangerous place to work today. But today's announcement was about Somalia, and the conditions that do not exist [there] in order for us to carry out humanitarian assistance. We are not able to put our people in place and to keep them safe, we are not able to do independent assessments, and ensure that the aid goes to them, that we are able to care for people who need the care most. So there are areas and aspects and various elements that have gone to us making this decision.

Now, you are right that we have more than 1,500 staff members in Somalia. They have all been informed about the closure, they've all had enough time to think about it. But unfortunately this is one of the consequences of the withdrawal. The patients and of course our staff, will in some way, shape, or form, pay the price of not being present in Somalia.

Michaeleen Doucleff, NPR (US):

I know that maybe MSF may not be directly linked to the polio campaign in Somalia, but do you know how the present violence and your withdrawal is going to affect the campaign to fight the polio outbreak there?

Dr. Karunakara:

I'm not going to specifically talk about the polio outbreak. We will do whatever it takes for a responsible withdrawal and also a responsible handover of our programs to local authorities, other agencies, et cetera. But the sad fact is that in many places people will be left with no care at all. No access to healthcare at all. And that is a sad reality in Somalia today.

I just want to stress a couple of things. It is not one incident that led us to make this decision. It is a series of incidents that have happened over the last 22 years, and also a realization that certain actors, certain authorities that we rely on, in many cases, for the safety of our staff, are actively supporting or tacitly approving attacks against our staff. There is also widespread disregard for the value of humanitarian action in Somalia today. So we are not in a position to provide assistance that is independent and impartial—by that I mean we are not able to go to all of the places where people need care and make assessments, and then promote operations that are appropriate for their condition. We are no longer able to have full staff in places so that the best possible services can be provided to people who need them. And this is a situation we find ourselves in and that's the basis on which we have made this decision to start stopping our activities in Somalia today.

Geoffrey York, the Globe and Mail (Canada):

Just to put this into context, can you give us a sense of whether MSF is the leading provider of medical care in Somalia? Are you the number one agency in terms of staff or clinics or medical care, so I can put this in context?

And second of all, you mentioned the early release of the killer in the case of the two most recent killings of MSF staff. Do you have any details on that? How was he released? Was that done before an official process? What is your objection to the early release of this killer? Was it done extra-judicially? What exactly do you object to in that case?

Dr. Karunakara:

First of all, there's no way of saying whether we are the largest provider of healthcare in Somalia today. Information is really hard to come by. And different organizations have different standards for measuring the care that they provide. But what I can say is that, just in 2012 alone, just last year, we provided more than 624,000 medical consultations, admitted 21,000 patients to the hospital, cared for almost 31,000 children, vaccinated almost 60,000 people, and delivered about 10,300 babies. So this is what we can present to you factually. And in Somalia, like I said, information is hard to come by, but we are certain that our withdrawal will lead to huge gaps in the places where we were working until today.

Now about the killings; the killings happened in the summer of 2011. We know who did it. The person was tried in a Somali court, and was given a 20-year sentence. But three months later he was released. And we have no idea of his whereabouts, and we have no information about how he is, what he is doing, et cetera. But our concern is that this signifies a certain lack of respect, or a certain turning of a blind eye to attacks against humanitarian workers and people who are providing care for Somalis. So that's our concern.

Marc Marginedas, Periodico (Spain):

I'd like to ask about the precedent of this decision—if MSF has ever pulled out of a country like you're doing now in Somalia. And the second thing is I'd like to know if the decision you announced today affects the Dadaab Refugee Camp in northern Kenya.

Dr. Karunakara:

There was one comparable event in MSF's history: Afghanistan in 2004, where five of our colleagues were killed—murdered. And in that situation the Taliban claimed responsibility for the attack and there was even an officer who was somehow involved in the execution of this attack. Now what we see is that the parties, the authorities, or the people who are in positions of power, who are the people who should be facilitating humanitarian assistance and making sure that their people have access to healthcare, are in many ways not doing so. There is a collusion, there is a turning of a blind eye against attacks, there are some actively supporting or targeting humanitarian actors, so these are commonalities that we find. So Afghanistan 2004 is probably the only other example in MSF's history where we have taken such a decision.

Now Dadaab remains an extremely dangerous place to provide healthcare. And we have extremely restricted our operations in the Dadaab refugee camps. But today's announcement is about Somalia, and the conditions that do not exist in Somalia today that will help the delivery of humanitarian care in that system.

Michael Goldfarb:

Arjan, do you have something to add?

Arjan Hehenkamp, general director MSF Operational Center-Amsterdam:

I'd just like to add that MSF is in the business of bringing healthcare to people in crisis and relieving people who are in crisis. And this is why it is such a painful and heavy decision, and such an unprecedented decision for MSF to feel compelled to leave Somalia.

I might add on a personal note that it's also one of the heaviest issues that I've had to participate in as a general director, particularly given the fact that I started my MSF time in Somalia in 1992. The circumstances are perhaps not completely comparable, but the situation at the time was also at crisis point. And security was tight. And so that has been a feature of our operations in Somalia for the two decades in which we have worked over there. But I can attest to the fact that when I was working it was possible to make agreements and arrangements hopefully and reasonably that allowed ourselves to work in that situation. The absence of that ability to be able to make arrangements and agreements with authorities, and the multitude of severe acts that have affected our organization is the reason that we are leaving today. So it's a massive decision, it's an unprecedented decision for MSF, and it's certainly very painful for primarily our patients and the population, but also for the organization.

Michael Goldfarb:

At this point I think we will conclude our press briefing for today. As a reminder, our participants were Dr. Unni Karunakara, MSF's international president, and Arjan Hehenkamp, general director of MSF's operational center in Amsterdam.

Please visit doctorswithoutborders.org or msf.org for the press release issued today announcing the withdrawal of MSF from Somalia and the closure of our medical programs there, and for additional information about MSF's operational history there.